| Organization Name: | HIGH COUNTRY BEHAVIORAL HEALTH |
| NPI Number: | 1063794394 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIPP DANA (EXECUTIVE DIRECTOR) |
| Mailing Address: | 24 Country Club Lane Pinedale |
| State: | WY US |
| Postal Code: | 829410856 |
| Phone Number: | 3073672111 |
| Fax Number: | 3073672166 |
| NPI Enumeration Date: | 09/13/2011 |
| NPI Last Update Date: | 09/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | LAT-220 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |